Ali Samina, Dworsky-Fried Zoë, Moir Mackenzie, Bharadia Manisha, Rajagopal Manasi, Gouin Serge, Sawyer Scott, Pellerin Stephanie, Bourrier Lise, Poonai Naveen, Stang Antonia, Leung Julie, van Manen Michael
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women and Children Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
J Pediatr. 2023 Jul;258:113405. doi: 10.1016/j.jpeds.2023.113405. Epub 2023 Apr 4.
To explore and understand parental decision-making relating to acute pain management for their children presenting to the emergency department.
This study employed one-on-one semistructured interviews. Parents of children with acute musculoskeletal injuries were recruited from 3 Canadian pediatric emergency departments. Interviews were conducted via telephone from June 2019 to March 2021. Verbatim transcription and thematic analyses occurred concurrently with data collection, supporting data saturation and theory development considerations.
Twenty-seven interviews were completed. Five major themes regarding pain care emerged: (1) my child's comfort is a priority, (2) every situation is unique, (3) opioids only if necessary, (4) considerations when choosing opioids, and (5) pain research is important. Overall, parents were highly comfortable with their assessment of their child's pain. Participants' willingness to use opioid analgesia for their children was primarily dependent on perceptions of injury and pain severity. Opioid-averse and opioid-accepting families had similar considerations when making analgesic decisions but weighed risks and benefits differently.
Parents assess and manage their children's pain globally and multimodally, with comfort being prioritized. For most parents, the desire to relieve their children's pain outweighed concerns of substance use disorder, misuse, and adverse events when making decisions about opioid analgesia for short-term use. These results can inform evidence-based family-centered approaches to co-decision-making of analgesic plans for children with acute pain.
探讨并了解家长对于前往急诊科就诊的孩子急性疼痛管理的决策过程。
本研究采用一对一的半结构化访谈。从加拿大3家儿科急诊科招募急性肌肉骨骼损伤患儿的家长。访谈于2019年6月至2021年3月通过电话进行。逐字转录和主题分析与数据收集同步进行，以支持数据饱和及理论发展方面的考量。
完成了27次访谈。出现了五个关于疼痛护理的主要主题：（1）孩子的舒适度是首要考虑因素，（2）每种情况都是独特的，（3）仅在必要时使用阿片类药物，（4）选择阿片类药物时的考量因素，（5）疼痛研究很重要。总体而言，家长对自己对孩子疼痛的评估非常有信心。参与者愿意为孩子使用阿片类镇痛药物主要取决于对损伤和疼痛严重程度的认知。对阿片类药物持反对态度和接受态度的家庭在做出镇痛决策时有着相似的考量因素，但对风险和益处的权衡有所不同。
家长从整体和多模式角度评估和管理孩子的疼痛，将舒适度放在首位。对于大多数家长来说，在为孩子短期使用阿片类镇痛药物做决策时，缓解孩子疼痛的愿望超过了对物质使用障碍、误用及不良事件的担忧。这些结果可为以家庭为中心的循证方法提供参考，用于共同制定急性疼痛患儿的镇痛计划。
